Advancing Empirical Research on Adverse Experiences, Spirituality and Health: Results from Prospective Cohorts Participating in the Study on Stress, Spirituality, and Health Dr. Alexandra Shields, PhD, Associate Professor of Medicine at Harvard Medical School (HMS) and Senior Scientist at Massachusetts General Hospital (MGH) and Director of the Consortium on Psychosocial Stress, Spirituality, and Health; Dr. Blake Victor Kent, Postdoctoral Research Fellow at the Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities; Ying Zhang, PhD, Senior Data Analyst at the Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities; Dr. Tyler J. VanderWeele is the John L. Loeb and Frances Lehman Loeb Professor of Epidemiology in the Departments of Epidemiology and Biostatistics at the Harvard T.H. Chan School of Public Health, Co-Director of the Initiative on Health, Religion and Spirituality, and Director of the Human Flourishing Program at Harvard University

Adverse psychosocial experiences that cause human suffering, such as the loss of a loved one, experiences of physical or sexual abuse, or poverty have been associated with increased risk of various chronic diseases. The stress pathway is one major pathway through which such adverse experiences “get under the skin” to dysregulate our biological processes for maintaining homeostasis and increase our vulnerability to disease. Key biomarkers of stress like telomere length have been associated with an increased risk of different chronic diseases, yet few prospective empirical studies have assessed the potential role of religious and spiritual beliefs and practices in supporting resilient responses to psychosocial stress. We discuss roadblocks to conducting these types of studies, our own efforts manifested in the Study in Stress, Spirituality, and Health, and ongoing projects examining religious beliefs and practices as they relate to human experiences of suffering. In particular, we examine: (1) attitudes about religion and spirituality (R/S) among Principle Investigators of major U.S. cohort health studies; (2) variations in R/S among five current participating cohorts, with implications for health; (3) the biological impact of childhood abuse on telomere length and potential R/S modification; and (4) the potential to use new measures of suffering to assess the effect of suffering on religious beliefs and practices and in understanding how religion may buffer the effects of suffering on health.

Advancing Research on the Role of Religion and Spirituality in Human Health: Promises and Pitfalls(Alexandra Shields, Chair and Presenter)

In our recent qualitative study in which we interviewed Principle Investigators (PIs) from 20 different NIH-funded prospective cohort studies, PIs emphasized that before they would be willing to add additional R/S measures in their data collection efforts, they would need to see high quality, prospective R/S studies that have been replicated in more than one cohort, with a plausible biological mechanism or pathway through which R/S affects important health outcomes. Our research center is also committed to conducting research that can help inform efforts to understand and address racial/ethnic disparities in health. Between 2016-2019, the Study on Stress, Spirituality and Health (SSSH) fielded an R/S Survey in 5 different high quality, prospective cohort studies (N=5,000) and includes fairly equal numbers of Blacks, whites, South Asians, American Indians and Hispanics/Latinos. In this presentation, we will review key themes raised by cohort PIs, present our conceptual model to guide the SSSH, and present the data and biomarker data we have generated thus far. We will close with an assessment of the promises and pitfalls of our research design, and implications for generating high quality R/S prospective research on R/S and health going forward.

Prevalence of Religious and Spiritual Practices and Beliefs in Diverse Racial/Ethnic Groups: The Study on Stress, Spirituality, and Health (Blake Victor Kent)Limited data sources exist which describe a broad array of religious and spiritual variables in multiple racial and ethnic groups. The SSSH collected data (with further collection ongoing) about understanding of religion/spirituality, beliefs, public religious activities, private religious activities, congregational support, relationship with God, religious coping, virtues, and several other spiritual items in Black, South Asian, white, Hispanic/Latino, and American Indian populations. Distributions of this variable array across these racial/ethnic groups will be discussed, highlighting differences between groups. Broad associations for links between religion and health—both positive and negative—will be briefly discussed, followed by several preliminary analyses of the links between R/S and hypertension.

Childhood Abuse, Spirituality, and Leukocyte Telomere Length: Results from the Study on Stress, Spirituality, and Health (Erica T. Warner) Telomeres are repetitive DNA sequences at the ends of chromosomes that prevent physical deterioration of the chromosome during cell division. Telomere length is considered an important biological marker of aging. We examined the association between abuse in childhood and/or adolescence and leukocyte telomere length among 957 participants in the Black Women’s Health Study (BWHS), 1,118 participants in the Nurses’ Health Study II (NHSII), 293 participants from the Strong Heart Study (SHS), and 519 participants in Mediators of Atherosclerosis in South Asians Living in America (MASALA). In models adjusted for childhood SES and demographics, compared to no abuse, moderate physical abuse in childhood was associated with shorter telomere length in NHSII and the meta-analysis. Compared to no abuse, severe sexual abuse in childhood or adolescence was associated with shorter telomere length in NHSII and in our meta-analysis. Experiences of severe physical and/or severe sexual abuse were also associated with shorter telomeres in multiple cohorts and in our meta-analysis. We observed little evidence of effect modification by the extent of positive or negative religious coping in cohort-specific or meta-analyses.

Suffering and Response: Directions in Empirical Research (Tyler VanderWeele)This paper provides a discussion of the current state of, and future possibilities for, empirical research on the topic of suffering. Discussion is given to the concept of suffering itself; existing empirical measures are reviewed and critiqued and a new multi-item measure of suffering, for use in both clinical and non-clinical populations, is put forward. The existing empirical research on suffering is briefly reviewed with considerable discussion given to potential future research directions on understanding the distribution and determinants of suffering, potential responses to suffering and their effectiveness, and the role of caregiving in the alleviation of suffering.